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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 9/2018

01-09-2018 | Pancreatic Tumors

The Impact of Hospital Neoadjuvant Therapy Utilization on Survival Outcomes for Pancreatic Cancer

Authors: Alexander V. Fisher, MD, Daniel E. Abbott, MD, Manasa Venkatesh, MS, Glen E. Leverson, PhD, Stephanie A. Campbell-Flohr, PhD, Sean M. Ronnekleiv-Kelly, MD, Caprice C. Greenberg, MD, Emily R. Winslow, MD, Sharon M. Weber, MD

Published in: Annals of Surgical Oncology | Issue 9/2018

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Abstract

Background

Many surgeons advocate the use of neoadjuvant treatment for resectable pancreatic cancer, however little is known about variation in the utilization of neoadjuvant therapy (NAT) at the hospital level.

Methods

The National Cancer Data Base was used to identify patients undergoing resection for pancreatic cancer between 2006 and 2014 at high-volume centers. Hospitals were grouped by NAT utilization using standard deviations (SD) from the mean as follows: high neoadjuvant utilizers (> 2 SDs above the mean, > 40% of patients receiving NAT); medium–high (1–2 SDs, 27–40%), medium (0–1 SD, 14–26%); or low (− 1.1 to 0 SDs, < 14%). Overall survival (OS) was compared across NAT utilization groups.

Results

Among 107 high-volume centers, 20,119 patients underwent resection. The proportion of patients receiving NAT varied widely among hospitals, ranging from 0 to 74%, with only five centers using NAT in > 40% of patients. These five hospitals had the longest median OS at 28.9 months, compared with 21.1 months for low neoadjuvant utilizers (p < 0.001). On multivariable analysis, high and medium–high NAT utilization predicted improved OS, with a hazard ratio (HR) of 0.68 (95% confidence interval [CI] 0.56–0.83, p < 0.001) and 0.80 (95% CI 0.68–0.95, p = 0.010), respectively, compared with low utilizers. After excluding patients who underwent NAT, there remained an association of improved OS with high NAT utilization (HR 0.74, 95% CI 0.60–0.93, p = 0.009).

Conclusion

High-volume hospitals that more commonly utilize NAT demonstrated longer survival for all patients treated at those centers. In addition to altering patient selection for surgery, high neoadjuvant utilization may be a marker of institutional factors that contribute to improved outcomes.
Literature
1.
Dimou F, Sineshaw H, Parmar AD, Tamirisa NP, Jemal A, Riall TS. Trends in receipt and timing of multimodality therapy in early-stage pancreatic cancer. J Gastrointest Surg. 2016;20:93–103.CrossRefPubMed
2.
Le A-T, Huang B, Hnoosh D, et al. Effect of complications on oncologic outcomes after pancreaticoduodenectomy for pancreatic cancer. J Surg Res. 2017;214:1–8.CrossRefPubMed
3.
Aloia TE, Lee JE, Vauthey J-N, et al. Delayed recovery after pancreaticoduodenectomy: a major factor impairing the delivery of adjuvant therapy? J Am Coll Surg. 2007;204:347–55.CrossRefPubMed
4.
Matsumoto I, Murakami Y, Shinzeki M, et al. Proposed preoperative risk factors for early recurrence in patients with resectable pancreatic ductal adenocarcinoma after surgical resection: a multi-center retrospective study. Pancreatology. 2015;15:674–80.CrossRefPubMed
5.
Xia BT, Habib DA, Dhar VK, et al. Early recurrence and omission of adjuvant therapy after pancreaticoduodenectomy argue against a surgery-first approach. Ann Surg Oncol. 2016;23:4156–64.CrossRefPubMedPubMedCentral
6.
Sugiura T, Uesaka K, Kanemoto H, et al. Serum CA19-9 is a significant predictor among preoperative parameters for early recurrence after resection of pancreatic adenocarcinoma. J Gastrointest Surg. 2012;16:977–85.CrossRefPubMed
7.
Gillen S, Schuster T, Meyer Zum Büschenfelde C, Friess H, Kleeff J. Preoperative/neoadjuvant therapy in pancreatic cancer: a systematic review and meta-analysis of response and resection percentages. PLoS Med. 2010;7:e1000267.CrossRefPubMedPubMedCentral
8.
Dhir M, Malhotra GK, Sohal DPS, et al. Neoadjuvant treatment of pancreatic adenocarcinoma: a systematic review and meta-analysis of 5520 patients. World J Surg Oncol. 2017;15:183.CrossRefPubMedPubMedCentral
9.
10.
Golcher H, Brunner TB, Witzigmann H, et al. Neoadjuvant chemoradiation therapy with gemcitabine/cisplatin and surgery versus immediate surgery in resectable pancreatic cancer. Strahlentherapie und Onkol. 2015;191:7–16.CrossRef
11.
Casadei R, Di Marco M, Ricci C, et al. Neoadjuvant chemoradiotherapy and surgery versus surgery alone in resectable pancreatic cancer: a single-center prospective, randomized, controlled trial which failed to achieve accrual targets. J Gastrointest Surg. 2015;19:1802–12.CrossRefPubMed
12.
Palmer DH, Stocken DD, Hewitt H, et al. A randomized phase 2 trial of neoadjuvant chemotherapy in resectable pancreatic cancer: gemcitabine alone versus gemcitabine combined with cisplatin. Ann Surg Oncol. 2007;14:2088–96.CrossRefPubMed
13.
Artinyan A, Anaya DA, McKenzie S, Ellenhorn JDI, Kim J. Neoadjuvant therapy is associated with improved survival in resectable pancreatic adenocarcinoma. Cancer. 2011;117:2044–49.CrossRefPubMed
14.
Parmar AD, Vargas GM, Tamirisa NP, Sheffield KM, Riall TS. Trajectory of care and use of multimodality therapy in older patients with pancreatic adenocarcinoma. Surgery. 2014;156:280–9.CrossRefPubMedPubMedCentral
15.
de Geus SWL, Eskander MF, Bliss LA, et al. Neoadjuvant therapy versus upfront surgery for resected pancreatic adenocarcinoma: a nationwide propensity score matched analysis. Surgery. 2017;161:592–601.CrossRefPubMed
16.
Mokdad AA, Minter RM, Zhu H, et al. Neoadjuvant therapy followed by resection versus upfront resection for resectable pancreatic cancer: a propensity score matched analysis. J Clin Oncol. 2017;35:515–22.CrossRefPubMed
17.
Birkmeyer JD, Warshaw AL, Finlayson SR, Grove MR, Tosteson AN. Relationship between hospital volume and late survival after pancreaticoduodenectomy. Surgery. 1999;126:178–83.CrossRefPubMed
18.
Fong Y, Gonen M, Rubin D, Radzyner M, Brennan MF. Long-term survival is superior after resection for cancer in high-volume centers. Ann Surg. 2005;242:540-4-7.
19.
Birkmeyer JD, Siewers AE, Finlayson EVA, et al. Hospital volume and surgical mortality in the United States. N Engl J Med. 2002;346:1128–37.CrossRefPubMed
20.
Ghaferi AA, Birkmeyer JD, Dimick JB. Variation in hospital mortality associated with inpatient surgery. N Engl J Med. 2009;361:1368–75.CrossRefPubMed
21.
22.
Edge SB, Byrd DR, Compton CC, Fritz AG, Greene FL, Trotti A. AJCC cancer staging manual. 7th ed. New York, NY: Springer; 2010.
23.
Piperdi M, McDade TP, Shim JK, et al. A neoadjuvant strategy for pancreatic adenocarcinoma increases the likelihood of receiving all components of care: lessons from a single-institution database. HPB (Oxford). 2010;12:204–10.CrossRefPubMedPubMedCentral
24.
Oettle H, Post S, Neuhaus P, et al. Adjuvant chemotherapy with gemcitabine vs observation in patients undergoing curative-intent resection of pancreatic cancer: a randomized controlled trial. JAMA. 2007;297:267–77.CrossRefPubMed
25.
Oettle H, Neuhaus P, Hochhaus A, et al. Adjuvant chemotherapy with gemcitabine and long-term outcomes among patients with resected pancreatic cancer. JAMA. 2013;310:1473.CrossRefPubMed
26.
Neoptolemos JP, Stocken DD, Friess H, et al. A randomized trial of chemoradiotherapy and chemotherapy after resection of pancreatic cancer. N Engl J Med. 2004;350:1200–10.CrossRefPubMed
27.
Katz MHG, Wang H, Fleming JB, et al. Long-term survival after multidisciplinary management of resected pancreatic adenocarcinoma. Ann Surg Oncol. 2009;16:836–47.CrossRefPubMedPubMedCentral
28.
Itchins M, Arena J, Nahm CB, et al. Retrospective cohort analysis of neoadjuvant treatment and survival in resectable and borderline resectable pancreatic ductal adenocarcinoma in a high volume referral centre. Eur J Surg Oncol. 2017;43:1711–17.CrossRefPubMed
29.
Petrelli F, Coinu A, Borgonovo K, et al. FOLFIRINOX-based neoadjuvant therapy in borderline resectable or unresectable pancreatic cancer. Pancreas. 2015;44:515–21.CrossRefPubMed
30.
Pingpank JF, Hoffman JP, Ross EA, et al. Effect of preoperative chemoradiotherapy on surgical margin status of resected adenocarcinoma of the head of the pancreas. J Gastrointest Surg. 2001;5:121–30.CrossRefPubMed
31.
Varadhachary GR, Wolff RA, Crane CH, et al. Preoperative gemcitabine and cisplatin followed by gemcitabine-based chemoradiation for resectable adenocarcinoma of the pancreatic head. J Clin Oncol. 2008;26:3487–95.CrossRefPubMed
32.
Evans DB, Varadhachary GR, Crane CH, et al. Preoperative gemcitabine-based chemoradiation for patients with resectable adenocarcinoma of the pancreatic head. J Clin Oncol. 2008;26:3496–502.CrossRefPubMed
Metadata
Title
The Impact of Hospital Neoadjuvant Therapy Utilization on Survival Outcomes for Pancreatic Cancer
Authors
Alexander V. Fisher, MD
Daniel E. Abbott, MD
Manasa Venkatesh, MS
Glen E. Leverson, PhD
Stephanie A. Campbell-Flohr, PhD
Sean M. Ronnekleiv-Kelly, MD
Caprice C. Greenberg, MD
Emily R. Winslow, MD
Sharon M. Weber, MD
Publication date
01-09-2018
Publisher
Springer International Publishing
Published in
Annals of Surgical Oncology / Issue 9/2018
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-018-6650-z

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